The most important fluid to drink is water. There is, in most cases, no difference between tap water, filtered water or bottled water. It is important to drink a volume of fluid that is healthy.
In some cases, particularly in established moderate to severe kidney disease, there is a need to limit fluid intake.
Most other people who don't have such severe kidney failure, the amount of fluid that should be drunk is that which is required to pass 1½ to 2 litres of urine volume per day.
I do not recommend 8 glasses (200mls) of fluid to be drunk per day which is often quoted. In the winter when the fluid body loss may not be so great this 8 glasses may be adequate. A similar volume may be adequate in office workers or people who work in a sedentary or similar non-physically demanding job or at home/indoors. People who may have a heavy labouring job, working outside in the heat/sun, or people who are very physically active (e.g. running, sports or regularly attending a gymnasium or fitness centre); or in the summer would be more likely to lose to more fluid from sweat. A higher fluid intake is required to keep the urine output up. Again primarily the fluid replacement should be water.
I encourage people to measure their urine volume over a 24 hour period as an indication of how much to drink rather than measure how much they drink per day. The urine output should be 1.5litres or more per day.
Maintaining a urine output at least 1½ to 2 litres per day is very important in people who are recurrent kidney stone or urinary tract infection sufferers.

Smoking may well harm your health more than just your kidneys. From the kidney perspective tar compounds that are in the inhaled smoke, clog up the blood vessels.
The blood vessels that supply the kidneys are very fine and only a small amount of deposit in their walls can lead to a significant reduction of blood flow and therefore loss of kidney function.

There are very few symptoms of kidney disease until the kidneys are severely affected. Usually kidney disease is picked up early, by early monitoring or screening blood (serum creatinine particularly) and urine tests (to detect blood and protein).
Symptoms may include:
• Nocturia (getting up at night to pass urine)
• Tiredness / lethargy
• Loss of appetite
• Increased or decreased urine volume
• Pain in the loin and groin (especially kidney stones)
• Discomfort over the bladder / lower abdomen area
• Discomfort from passing urine (often urinary infections are not associated with kidney disease)
• High blood pressure.

Prescriptions Medications
Many prescription medications are excreted by the kidney, or their breakdown products are excreted (removed from the body) by the kidney. They can potentially harm the kidney especially if they are concentrated in the kidney. Increasing urine volume
by having a high fluid intake can help prevent kidney disease from drugs.
Sometimes prescription medication dosing needs to be adjusted in people who have kidney disease or the elderly.
Common prescription medications that may affect the kidney include:
• Lithium
• NSAIDs (non steroidal anti-inflammatory drugs)
• Some pain relief medication (particularly NSAIDs) Cox II inhibitors (arthritis or anti-inflammatory medications)
• Proton pump inhibitors – e.g. omeprazole
• Some cholesterol lowering agents e.g. fibrates. The statins e.g. simvastatin and atorvastatin are generally "safe" to use in kidney disease.OTC/non prescription medications.
Medications that can be purchased over the counter (OTC) at health food shops, chemists and supermarkets sometimes have combinations of active ingredients. Most of these are quite safe to use but some may have kidney damaging components, particularly in people who have established kidney disease. Before starting these medications it is worth checking with the person who sells them in the shop, or getting further information from a health professional. Sadly many of the medications are only harmful after a long time of exposure and the damage is then irreversible. This is an important point because often the kidney damage has no symptoms early in the process.
• If you know you have kidney disease it is wise to check with the person supplying the medication if it is safe to use.
• Some agents are marketed as being "safe" or as treatment for kidney disease and yet are harmful.
• Some medications that are marketed are toxic.

Frequently Asked Questions about Kidney Transplantation

A kidney transplant is a surgical procedure in which a kidney is removed from one person (donor) and placed into the body of a person suffering from renal failure (recipient), in whom the transplanted kidney can perform all the functions which the patient's own kidneys are not able to perform.

When a person has 'RENAL FAILURE', the kidneys do not properly filter harmful waste products; as a result, excess wastes and chemicals start to accumulate in the blood. When this happens, a dangerous accumulation of waste products can occur, causing a condition known as uremia.
Patients with irreversible renal failure have two options of treatment:
1. Dialysis, where the waste products from the blood are removed artificially.
2. Kidney transplantation
Any patient whose own kidneys have failed permanently is a potential candidate for a kidney transplant. There are several factors in each individual case, which determine whether a kidney transplant or lifelong dialysis is the better form of treatment for that patient. These factors include age, availability of family donors and the presence of antibodies in the patients (this increases the risk of kidney failure after transplantation). The health factors which increase the risk of the transplant operation are mainly heart disease, cancer or infection.

The removal of the kidneys (Nephrectomy) which are diseased is usually not necessary prior to the time of transplant. The original kidneys may have to be removed if they are producing damaging effects in the body, such as in case of
1. High blood pressure (due to original kidneys), that cannot be controlled by the use of medications.
2. Infected kidneys, with recurring urinary tract infection.
3. Large polycystic kidneys.

1. There is no dependence on the machine thrice a week for the rest of one's life.
2. There are hardly any restrictions in the diet and fluid intake after a successful transplant.
3. The physical sense of well-being is so much better that one can go back to work in a style similar to that before the illness.
4. Usually the anaemia (and feeling of tiredness) seen in patients with renal failure is reversed after a successful transplant, since the kidney is functioning to maintain normal red cell production. For patients on dialysis, correction of anaemia requires life-long use of erythropoietin injections which are extremely expensive.
5. A woman may be able to conceive a child after having a successful transplant. (Women on dialysis usually do not ovulate and therefore are unable to become pregnant.)
6. Men who may be having sexual problems such as inability to maintain an erection may find this problem eliminated once they receive a successful transplant.

Kidneys are obtained from 4 sources:1. CADAVER DONORS : A cadaver kidney is removed from an individual who has been declared as brain-dead from non-kidney related causes, such as an accident or a stroke. Since a cadaver kidney is from a person not related to the patient, the kidney has less possibility of close antigen matching and thus less chances of success. Also, the recipient has to wait till a suitable kidney is obtained. In our country, cadaver organs are not yet a practically feasible alternative, though legislation for making removal of organs from cadavers has been passed in Parliament. 2. LIVING RELATED DONORS: Very close relatives-parents, siblings (brothers & sisters), children, grandparents may donate a kidney to a near relative. This is because a normal individual has two kidneys and can live safely in good health with one kidney. Kidney donation does not alter the physical capacity or life-style or longevity of life of such a donor.
3. EMOTIONALLY RELATED RECIPIENT DONOR MOTHER KIDNEY DONOR :In the situation where cadaver donor transplant is not available & living related donors are found unfit, emotionally related kidney donors like spouse (husband/wife) cousins, uncles, aunts, in-laws may donate a kidney and they are called emotionally related kidney donors. 4. UNRELATED KIDNEY DONORS :When cadaver donors, living related donors, emotionally related donors are not available or are found unfit, then unrelated donor kidney transplantation can be considered. Patients should understand that the chances of rejection are higher & costly medicines like Cyclosporin-A, ATG, etc. have to be taken for better function of the transplanted kidney.
A kidney donor should have a compatible blood group, age above 18 years and preferably below 60-65 years and should not have any major disease. In the absence of all the above potential kidney donors, the only option for such patients is lifelong dialysis which is very expensive and which may not be available to the patient where he is staying

Frequently Asked Questions about CKD

Chronic kidney disease is permanent kidney damage due to injury or disease. CKD ranges from mild to severe. If CKD reaches the point of kidney failure, dialysis or a kidney transplant is needed to support life. Since CKD may worsen over time, early diagnosis and treatment can help slow down the damage, depending on the cause of the problem (see Chronic Kidney Disease: What You Can Do). If your doctor says you have a kidney problem, find out the medical name (and spelling) for your diagnosis, if you can. Knowing the name can help you look for more information.

Many people think that if their kidneys fail, they will die immediately. This used to be true 40 years ago when there were not enough dialysis machines to go around and medical knowledge about kidney disease was limited. It is no longer true today. How long you can live with CKD depends on your age, other health problems, and how involved you become in your care. Some people with early CKD never have kidney failure. Others reach kidney failure and live for decades with dialysis or kidney transplants. There are major advances in today's healthcare—we have better drugs, know more about how to slow down kidney failure, and have technically advanced dialysis machines. But the most important factor is still the individual who has the disease. Research shows that patients who become partners in their care live longer. So, ask questions, and explore with your doctor and care team the best way for you to help manage your disease.

How good your life can be with CKD depends on you! In the early stages, CKD may have symptoms that are so subtle you don't even notice them. In later stages, fatigue, itching, loss of appetite, and other symptoms can reduce your quality of life—if you don't act. How? All of these symptoms can be treated. Learn what to watch for and tell your doctor, so you can get the help you need. You can also keep a good quality of life by following your treatment plan. For example, taking your medications in the right doses at the right times may help slow down your kidney disease. Your quality of life with CKD depends on your attitude, and how you accept the changes and take control of your health and your life.

Yes, you can live long and live well with dialysis. Many people—even those with family members on dialysis—don't know that there are several types of dialysis. You can choose a type of treatment that lets you keep doing all or most of the things you value. Some people with CKD put off dialysis as long as they can, because they are afraid. But people who start treatment before they are terribly ill and malnourished do much better. And people who are very sick before they start dialysis are often surprised to find that they feel much better a few weeks or months after starting dialysis. The unknown that you imagine is often much scarier than the reality. Learning as much as you can, and talking to patients who are doing well, will help you see that you can have a good life on dialysis.

Even healthy people complain of being tired. But people with CKD can be so exhausted that they fall asleep during the day—even after 8 to 10 hours of sleep at night. One reason for fatigue can be anemia, a shortage of oxygen-carrying red blood cells. People with CKD often have anemia because damaged kidneys make less of a hormone called erythropoietin (epoetin, or EPO). EPO signals the bone marrow to produce new red blood cells. Without a constant supply of new red blood cells, the body has less oxygen—so you are more tired, feel cold, can't concentrate, and are less able to fight disease. Untreated anemia can damage your heart, and heart disease is the leading cause of death for people with CKD. If your fatigue is due to anemia, your doctor may prescribe injections of a synthetic form of EPO.

There are a number of treatments, including medications and lifestyle changes, that may help keep your kidneys working longer. People can even get transplants before having dialysis, especially if they have a willing living donor. You need to ask your physician exactly what would help you. For more information on possible treatments, see Chronic Kidney Disease: What You Can Do.

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About

Dr. Abhay N. Sadre, an eminent nephrologist of pune is one of the leading nephrologists in India.
He passed his MD(Medicine) from Aurangabad,Marathwada University in 1988 and DM(Nephrology) in 1994 from Bombay University, Mumbai. Dr. Sadre offers curative services,kidney transplant, dialysis. The facility is well equipped with all modern gadgets and diagnostic and surgical equipment.